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Wednesday, December 31, 2014

I learned recently that among our neighbors in this
valley community is producer John Hoffman, Founder and CEO of HBO’s “The Public
Good Projects.” Among its noted productions is the 2012 series, “The Weight of
the Nation.” On the chance that I might meet Mr. Hoffman at a holiday party, I
decided to watch all four “Main Films.” In anticipation I took copious notes to
share some good news with my readers as we embark on the New Year. Sadly, I was
largely disappointed.

These feature-length films, all available now on
YouTube, are: Consequences, Choices, Children in
Crisis and Challenges. Each feature is divisible
into finite chapters capable of being linked and shared. Each film is very well
produced and deals thoroughly and comprehensively with “the problem” – in the
sense that it accurately portrays the obesity epidemic in America, and
accurately depicts the timeline in which it developed. There’s also a small segment of very good science on
the “ancestral” POV, so again, I was hoping that the producers would reach the
logical conclusion and make “the turn.”

I was hoping that, given the agreed-upon time line
for the start of the dramatic upswing in weight, and this “ancestral”
perspective, the producers would correctly “nail” the problem: Government’s
insistence since 1977 (“The McGovern Commission Report”), and 1980 (the first
iteration of the “Dietary Guidelines for Americans”), that we eat a low-fat
(high carb) diet. The well-meaning bureaucrats and their minions had begun the
largest public health experiment in history, encompassing virtually every
American. Palpably, it has been a catastrophic failure.

My hopes were high. That pre-disposition is always
my bias. Besides, if I don’t lean that way, the tsunami of bad nutritional
advice out there would “swamp my boat.” So, my ears perked up when I heard,
“What makes me frustrated bordering on angry is the fact that this [obesity
epidemic] is preventable.” I think it was said by Robert Lustig, MD, the
pediatric endocrinologist whose 2009 YouTube video, “Sugar: The Bitter Truth,” went viral. Other quotes
of his were, “…insulin is not working well at the level of the cells,” “…juice
and juice drinks are as bad as soda,” and “sugar is where you start.” He also
asked, “What changed in the last 30 years to make this obesity epidemic
happen?” His answer: “In the last 30 years our DNA has not changed, but our
environment has.” I waited for him to
amplify, but alas, neither he nor I produced this film.

Lustig was practically the only ray of hope I saw in
this four-plus-hour presentation. The preponderance of experts said stuff like,
“The reason we have government in the first place is to solve problems
collectively that we can’t solve individually.” (Thomas Farley, NYC Health
Commissioner); “We could have eaten better. We don’t have to have steak, and we
don’t have to have roast beef,” and “Eat less, exercise more, eat a balanced
diet.” (Francis Collins, head of the National Institutes of Health); “For all
intents and purposes, a calorie is a calorie is a calorie; energy-in equals
energy-out.” (Rudolph Leibel, Co-Director of the NYC Obesity Research Center at
Columbia University); and “Follow a medically advised diet.” (Kelly Brownell,
PhD, Director of the Rudd Center for Food Policy and Obesity at Yale
University).

My favorite “quote” from my scribbled notes was from
Courtney Rowe, Deputy Communications Director of the by-definition-compromised
USDA: “While it is unfortunate that some in Congress choose to bow to special
interests, the USDA remains committed to practical science-based standards for
school meals that improve the health of our children.” N.B.: Rowe was
Communication Director for the Senate Agriculture Committee when Dems
controlled the Senate.

It would be less ironic if this political-pot-shot
from Rowe in “Children in Crisis” (Part 3) hadn’t been followed in “Challenges”
(Part 4) with these facts: 1) Government subsidy programs are heavily tilted
toward the large commodity crops of wheat, corn, sugar and dairy, 2) livestock
and poultry feed are subsidized indirectly by cheap feed: corn, soy and other
grains, 3) “it is government policy to overproduce what we are already
overeating,” and 4) 50% of U.S. farmland is planted in corn and soybeans). I
think these points were made by David Wallinga, MD, at the Institute of
Agriculture and Trade Policy, who deserves to be promoted (or fired). Eric
Finkelstein, an economist at Duke University, added, “Obesity rates correlate
with corn and soy production.” (low-cost HFCS and soy-based fats and oils).

But this “Documentary” (Commercial?) concludes with
Daniel Glickman, former Secretary of Agriculture and current Chair, Committee
on Accelerating Progress in Obesity Prevention, saying in a voiceover, “To be
healthy we need to eat healthy and exercise more.” The video clip shows a guy
on a treadmill saying, “I needed to do something” (about weight). I think it
was Mayor Dean of Nashville, TN, who added greenways for cyclists and parks in
poor neighborhoods.

The old saw, “Your zip code matters more than your
genetic code,” has now evolved to, “Being wealthy is not nearly as protective
against obesity as it used to be.” I like it because it brings us back to how what we eat has changed, and again to David Wallinga: The increase in calories
in our diet, he says, is attributable to “25% added sugars from corn, 25% added
fat from soy, and 50% refined grains from corn starches, wheat, and the like.”
The result: food costs ↓; health costs ↑.

N.B. “The Weight of the Nation” was produced by a
partnership of “HBO Documentary Films and the Institute of Medicine, in
association with the Center for Disease Control and Prevention, the National
Institutes of Health, the Michael and Susan Dell Foundation, and Kaiser
Permanente.” That means they paid for these films. At least it wasn’t Cargill
and ADM, directly…

Saturday, December 27, 2014

I had to
laugh. Of course, by “everyone” the title of this
Medscape
piece meant, I thought, as the “Initial Choice of Oral
Glucose-Lowering Medication” for [treatment of type 2] Diabetes Mellitus.” But
for a moment I thought that the authors meant “everyone everyone.”
That’s the way the
new guidelines for prescribing statins are being interpreted, at least
for everyone over 39 years of age (and under 76),
and that for the very dubious, almost exclusive purpose of lowering
LDL-C. But if you want to read about that, you can go to The Nutrition Debate #
180, “The
AHA/ACC Cholesterol Guidelines.”

No, this
story, published in JAMA
Internal Medicine, was an “observational cohort study [that] sought to
determine the effect of initial oral glucose-lowering class on subsequent need
to additional anti-hyperglycemia therapy.” The 15,516 participants, none of
whom had previously been treated for diabetes, were started on 1) metformin, 2)
a sulfonylurea, like glyburide or glipizide, 3) a TZD like Avandia, or 4) a
DPP4, like Januvia and Onglyza. “The primary outcome was time to treatment
intensification, defined as initiation of a different class of oral
glucose-lowering medication,” Medscape
said.

“The
Winner, and Still Champion: Metformin,” the Medscape
sub-head declared. Well, there should be no surprise there. But if you are now
pre-diabetic, or when first diagnosed a type 2 diabetic, you aren’t (weren’t)
started on Metformin, you might want to print this post out – better yet, go to
the Medscape and JAMA Internal Medicine links above, print them out, and give them to your doctor and ask why you were not. I’d be interested to hear his or her answer.

The
FINDINGS: “58% of the patients began therapy with metformin, 23% with a SU
[sulfonylurea], 6% with a TZD and 13% with a DPP4.” During the “median
follow-up of slightly more than 1 year, subsequent treatment intensification
differed significantly by drug class. Of patients prescribed metformin, 25%
required a second oral agent, compared to 37% of SU recipients, 40% of TZD
recipients, and 36% of patients taking a DPP4.” This implies significantly
different effectiveness.

As to the
“secondary outcomes,” Medscape states this simple but dramatic finding: “Also
relative to metformin, SU use was
associated with an increased risk for composite cardiovascular events,
congestive heart failure, and hypoglycemia.”

Then this
Medscape analysis of comparative effectiveness took an interesting turn. It
began with this question, posed by another
study: “Can People With Type 2 Diabetes Live Longer Than Those
Without? A Comparison of Mortality in People Initiated With Metformin or Sulphonylurea
Monotherapy and Matched Non-diabetic Controls.” This British study, which
appeared in Diabetes Obesity and
Metabolism, essentially asked, “Does Metformin Reduce Mortality?” Hmmm…
Maybe the title of the Medscape piece
was intended to mean “everyone everyone.” I read on to find
out.

In this
study, “patients initiating metformin therapy were compared with those
initiating treatment with a SU, and both diabetic groups were compared with
their matched nondiabetic controls.” Subsequent mortality was tracked for up to
5.5 years. The FINDINGS: “Crude death rates were substantially lower for
metformin users that SU users” and, “All subgroup comparisons favored metformin
over SU and were statistically significant.” But here’s the zinger.

“Perhaps
the most striking finding was that survival time for controls [the
non-diabetics who were not taking
metformin] was 15% shorter than for matched metformin users. This finding was
consistent across all subgroups, nearly all of which demonstrated statistical
significance, and was particularly strong among patients with high
comorbidity.”

“The
protective effect of metformin relative to SUs was not a surprise,” the
Medscape piece says. The remarkable finding was an apparent protective effect
of metformin compared with nondiabetic individuals. Because of metformin’s
favorable results among people with diabetes, it has been postulated that the
drug may also provide benefit to people without diabetes.” Sort of like statin
therapy… What are they saying? What am I saying? Everyone should take
metformin??

Wednesday, December 24, 2014

As I write this (on December 7th), I’m
thinking my readers will get this message in their inbox on Christmas Eve. I
don’t know about you, but I’ll be busy with family, eating a wonderful
smorgasbord and watching grandchildren open presents (from family). They will
wait until morning to open others that arrive “down the chimney” later that
night. So, I’m thinking my message should be one of comity and “on earth, peace
to men of good will” (Luke 2:14; Codex
Sinaiticus translation).

We live in a world increasingly rent by division,
and this applies to the world of nutrition policy as to any other field of
human endeavor. Accordingly, this column frequently positions itself fervently
in opposition to the perceived wisdom in broad areas of public policy
respecting a “healthy diet.” We (in the royal sense) were originally motivated
to take on the establishment view after the premature death of a friend. He was
an insulin-dependent type 2 diabetic who happened also to be my pharmacist. His
death, from one of the comorbidities of type 2 diabetes, was tragic and
unnecessary.

Out of this sense of his loss I was motivated to
begin writing this column over 4 years ago. I later wrote about my pharmacist
in The Nutrition Debate #114 here. And I also wrote “an
appreciation” (#95 here), upon learning of his
death, of the doctor who introduced me to the Very Low Carb Way of Eating, i.e.
VLC WOE. Doc just wanted me to lose
weight, but he said, with his hand on my shoulder as he walked me down the
hall, “It might just help your diabetes too!” That was 12½ years ago.
Little did he know how profoundly it would change my life. It changed
everything, really. I seriously don’t think I would be alive today…had I not
taken his advice…and lost 170 pounds.

Everything else changed too, most notably my blood
markers. My triglycerides dropped by 2/3rds (to around 50mg/dl); my HDL-C more
than doubled (from 39 average to 84 average); my A1c dropped (originally) to
the mid 5s (they’re starting to creep up recently though); and my hs-CRP, an
inflammation marker, has been between 0.1 and 2.7mg/L (aver. of 13: 1.4). In
addition, I feel GREAT! I always have LOTS OF ENERGY, and I have no joint,
back, hip or knee issues. Even early signs of arthritis, which began to appear
about the time I started this WOE, have disappeared. And my body “tags” all
dropped off.

Then yesterday, at our local Christmas season
concert and tea, I saw an old friend. He’s been reading this column for years.
He was of “good cheer,” a jolly old soul indeed, but alas I’m afraid I quashed
his spirit because I lectured him (and his wife). He is still as plump as Saint
Nicholas himself, and I am dispirited. I am forlorn because I worry for him.
It’s tough to accept sometimes that the best I can do to help people is
sometimes just not enough. I need to remind myself of the American theologian
Reinhold Niebuhr’s Serenity Prayer:

“God, grant me the serenity to accept the things I
cannot change,

The courage to change the things I can,

And
the wisdom to know the difference.”

So, my
“Annunciation to the Shepherds” message is simple; it is one of “good tidings
of great joy, which shall be to all people” (Luke 2:10; King James Version) who would listen:

Insulin Resistance =
Carbohydrate Intolerance

If you are rotund, the “expression” of your genotype
is undoubtedly characterized by a progressive condition called Insulin Resistance
(IR). And if you have IR, you are CARBOHYDRATE INTOLERANT. If you want to live
a long, happy and healthy life, you need to give up most of the carbohydrates
in your diet. There’s a week left in the year to consider whether this would
make a good New Year’s resolution. If you agree, we will guide you. Read our
twice-weekly blog posts and write to me using the Blogger link or email me
directly at danbrown@thenutritiondebate.com. I will do my best to
support your decision and lifestyle change.

In any case, whether you decide to transform your
life or not,

WE WISH YOU A MERRY
CHRISTMAS

We wish you a merry Christmas
We wish you a merry Christmas
We wish you a merry Christmas
And a Happy New YearREFRAIN
Good tidings we bring to you and your kin,
We wish you a merry Christmas and a Happy New Year.

Saturday, December 20, 2014

An
article in The Washington Post
caught my attention: “Falling asleep causes 1 in 5 auto crashes.” The finding
is based on new research of 14,268 crashes from 2009-2013 in which one vehicle
was towed from the scene. The AAA Foundation for Traffic Safety analyzed the
data and commented, “Like distraction, there are limitations in relying on
crash-involved drivers to realize, remember and willfully report their level of
impairment.” Therefore, the AAA investigators said, “This study leveraged
findings from trained crash investigators, as opposed to police reports, as a
source of data.”

Okay, as a
practiced debunker of bogus or biased “research,” I could take issue at the
“overreach” of their study design, the “factors” taken into consideration, the
“confirmation bias” of the AAA and their “public health” agenda and advocacy
disposition, but I won’t. The reason this caught my attention is that I could
relate. In years past I almost killed myself (and sometimes another) on
numerous occasions – too numerous to recount – by nodding off behind the wheel.

The reason,
however, was not “fatigue” (lack of sleep) in the usual sense; it was low blood
sugar (NOT hypoglycemia). Now it’s true that I have been a diagnosed type 2 diabetic for 28 years, which means I have probably
been a type 2 for 30 to 35 years (since I was in my late 30s). This also means
I was undoubtedly a pre-diabetic or 5 or 10 years before that, going back to my
late 20s or early 30s. Why is this relevant? I will cite a source for the
“history” of the development of type 2 diabetes – the mechanisms – a little
later, but first I’ll cite some examples of common behavior that everyone can
relate to.

In a few
days we are going to celebrate Christmas. In our house, some adults eat almost as many Christmas cookies (and other baked
goods full of sugar and butter) as the children do. We give ourselves “a pass”
a few times a year to indulge in the goodies we would normally pass on. We also
have fresh in our memories a similar feast of Thanksgiving just a few weeks
before when we ate loads of starchy vegetables and stuffing and gravies passed
around the table “family style.” It’s a wonderful tradition. And it’s equally a
tradition for some overstuffed family
members to “feel sleepy” after a “big meal.” Others go for a walk in the brisk
late-fall air to increase their peripheral circulation and stave off that
sleepy feeling.

Now we all
know that we (most of us, except the cook!) are not suffering from a lack of
sleep, or even a few stressful days leading up to the big meal. We are
suffering from a lack of blood in the peripheral areas (arms and legs) and
brain while the blood concentrates in the central areas to process, digest and
absorb all the “energy” we ate. The extremities get short shrift, as they
should. The body does this autonomically. It’s natural. Animals like big cats
take a long nap after devouring enough of their catch to carry them days or
even longer until they are fortunate enough to make another.

But the
“big meal” syndrome is only part of the picture. People who have, or almost
imperceptibly are beginning to have, a compromised glucose metabolism – like I
was in my late 20s and early 30s – are simultaneously experiencing a different
physiological phenomenon: our blood sugar routinely becomes elevated (“spikes”)
above the normal +/- 140mg/dlafter
a meal. People with a healthy glucose metabolism never have a
blood sugar above 140mg/dl, even after a big meal. But people with a compromised
glucose metabolism, who eat a lot of carbs, always spike higher.

This is the
result of the loss of the 1st
insulin response in which the pancreas produces a spurt of insulin in
anticipation of and at the onset of eating and the beginning of insulin resistance in which the
destination cells (muscles, etc.) for the glucose circulating in our blood have
developed resistance to the insulin that is transporting the glucose. The
result is that the glucose is not “taken up” as quickly. It continues to
circulate and we have “high blood sugar.” Then, slowly, for the prediabetic (but not
the un-treated T2), what goes up must come down. Your blood sugar crashes,
and you “feel tired.”

If you’re
interested, the mechanism of how someone who is genetically predisposed to
having a dysfunctional glucose metabolism, and who eats the Standard American
Diet (SAD), is explained by the 2008 ADA convention keynote speaker and
Banting Award winner Ralph DeFronzo, MD, in The Nutrition Debate #99, “Natural
History of Type 2 Diabetes.”

But for the less
technically inclined, just know this: If you’ve gained weight eating the diet
recommended by the USDA’s Dietary Guidelines, and the medical establishment (ACC/ADA), and their members who have no
training in nutrition, then consider that it may be that your glucose
metabolism is starting to unravel. If you “feel sleepy” after a big meal, it
may be more than just all your blood rushing to the stomach to deal with your
excesses. It may be a sign that you need to cut back on sugars and starches
(i.e. on all dietary
carbohydrates) that you eat. The life you save may be your own, or your
family’s.

Wednesday, December 17, 2014

Among the
myriad missives that arrive in my inbox daily are offers of Continuing Medical
Education (CME). This
half-hour video (with transcript) from Medscape LLC is worth 0.50 AMA
PRA Category 1 Credits and was supported by an educational grant from Takeda
Pharmaceuticals and Orexigen Therapeutics (drug makers).“This activity,” Medscape says, “is intended
for primary care clinicians, endocrinologists, diabetologists, and other allied
healthcare professionals who manage patients who are obese.” I am always
interested in how the medical profession manages to mangle this subject, so I
watched it.

“The goal
of this activity,” Medscape avers, “is to focus on the global public health
crisis of obesity and to demonstrate how motivational interview techniques can
be used by clinicians to help patients who are overweight or obese establish a
partnership with their clinician and foster patient adherence to an
individualized weight loss management plan.”

To
recapitulate, here’s the plan: Scare the patient with the obvious – the
prevalence of obesity and its unhealthy consequences and co-morbidities; then,
if they are ready, help them by using “motivational interview techniques.” Do
this by “partnering” with them to “foster” adherence and develop an
“individualized weight loss management plan.”

Motivational
techniques can help, I suppose, but “public health statistics” wouldn’t
motivate me. Besides, everybody already knows that. The key is the patient has
to be of a frame of mind to be ready to 1) personally want to try (again) to
lose weight, and 2) the patient has to have a level of confidence that the
weight loss plan will work. The two critical points are 1) “are you ready?” to
lose weight and 2) the weight loss plan itself. It’s a critical one-two
combination punch.

That being
said, some of the questions the video posed to assess the motivational
readiness of the patient were good. Absent the readiness on the part of the
patient before the interview, this type of questioning might be fruitful.

●How
important to your health is getting your weight under control?

●What is
your biggest barrier to losing weight?

●What do you
think you could do to lose weight?

●How
confident are you in your ability to lose weight?

So, whether
you come to your doctor’s appointment already motivated (as I was – see the
penultimate paragraph of #260), or
whether your doctor thinks he cajoled you into trying to lose weight again, the
key
is having a level of confidence that the weight loss plan you follow will work.
This is where the video fails miserably
and utterly to produce a knock-out punch. In fact, I would say the medical
doctor who gave this advice should never even have put on gloves and gotten
into the ring.

The match
started to “go south” when in response to “what do you think you could do to
lose weight?” the video suggests “exercise” and “eat smaller portions.” And
instead of “eating a lot of high calorie foods” (that would be fat, right?),
the doctor prompts you to “eat more vegetables” (all carbohydrates!). This doctor may know something about
“motivational techniques,” but he clearly knows nothing about effective
(“efficacious” in pharmaceutical- talk) weight loss plans.

He suggests
seeing the patient once a month for 6 to 12 months to “create a partnership”
and “foster adherence” to the “individualized” plan that you formulate
together. He also suggests using this time to “direct the patient in the direction you’d like them to go.” And
there’s the rub. All clinicians who treat the overweight and obese know that that so-called “individualized”
direction – to “exercise more, eat smaller portions, eat less fatty food and
more vegetables,” is doomed to fail. Their patients are going to be hungry all
the time. They are not going to lose
weight or keep it off. (What do they think you’ve been trying to do all this
time?)So what then? Weight loss drugs?
Hmmm… I’m beginning to see the value of pharmaceutical companies providing
“educational grants” so that, if all else fails, having “fostered” a
relationship, you can “partner” the patient “in the direction you’d like them
to go.”

“Upon
completion of this activity,” Medscape says, “participants will be able to:

1.Identify health consequences of untreated obesity and
its association with the development and progression of comorbidities.

Okay, I got the “scare the
patient” part. It’s the “translate” part that doesn’t work for me. “Drug speak”
is not the way to manage obesity. Nutritional counseling to cut out
carbohydrates is, however, an effective weight loss management plan.

Saturday, December 13, 2014

Long before
I started writing this column – but years after
I discovered the Low-Carb, High-Fat (LCHF) Way of Eating (WOE) – I discovered
an article called “The
Skinny on Fats” and saved the link as a “favorite.” My link still works, as
do links to other articles, “The Oiling of
America” and “The
Truth About Saturated Fat,” by the same authors.The authors are Sally Fallon Morell and Mary G. Enig, PhD.
Sally is the founding president of the Weston A. Price Foundation. Mary,
co-founder and vice president, died a few months ago. An appreciation by Kaayla
Daniel, PhD, her successor, appears here.The website is worth a look.

“The subject of fats and oils is complicated
and fraught with misconceptions – so much so that explaining the myths and
truths about fat can be long and complicated. People’s eyes glaze over when you
try to explain it all, even though information on fats and oils can be life
changing and life saving. Brownstein and Shenefelt have solved these hurdles
with this very well put together book on fats and oils.

The authors start with a summary of
surprising facts about fats:

1.We need fat in our diet to live!

2.Fat does not make us fat!

3.A low fat diet is not healthy!

4.Fat performs many essential functions in our bodies!

5.Some dietary fats are better than others!

6.Saturated fat is not the enemy!

7.Saturated fat and cholesterol do not cause heart
disease!

8.Dietary fat is not the culprit of disease!

9.Canola oil and other refined vegetable oils are not
healthy for you!

10.Low-cholesterol food does not do your body good!

Even if readers go no further than this short
introductory section, they will be much wiser than before. But for those who
want more information, there follows chapters that detail the structure of
fats, the different types of fats and oils, the role of cholesterol in the body
and problems with low fat diets. Particularly interesting are discussions on
your brain’s absolute dependence on fat and how eating fat can assist with
weight loss. The authors point out that getting enough fat affects mood and
behavior, cognitive function, mental acuity, focus and clarity. Low fat diets
can lead to depression, reduced mental capacity and behavior problems.
Cholesterol is concentrated in the myelin sheath so attempts to reduce
cholesterol can lead to serious degenerative disorders of the nervous system,
including multiple sclerosis and dementia.

Brownstein and Shenefelt devote a whole chapter to the
subject of fats and children – for it is our children who are paying the
greatest price for the anti-saturated fat, anti-cholesterol folly. Children’s
brains need lots of fat and cholesterol for proper development. Children need
butter, eggs, cream, cheese and meat fats, not margarine, spreads and low fat
products.

The book ends with a nice collection of recipes
dripping with butter, cream and cheese. Thumbs up.”

The message
here, and in The Nutrition Debate #269, (just below) and in #20, “Know
Your Dietary Fats,” and is #23, “The
Benefits of Saturated Fats,” is that saturated fats are not only good but necessary fats. The fat soluble
vitamins, A, D, E and K, require fat to absorb optimally. Message Two is that
the refined vegetable oils, which are manufactured from primarily
polyunsaturated fats, are bad for
you; Read #21, “The
Dangers of Polyunsaturated Fats.” But if you read nothing else, please read the Enig and Fallon article,
“The
Skinny on Fats.” If you take it to heart, as Morell says, it will be life changing and potentially
life saving.

N.B.: A Senior Membership in the Weston A.
Price Foundation is just $25 (Regular Membership $40). It’s a good thing.

Wednesday, December 10, 2014

In bold black letters on a yellow field, the
post-card-sized thank you note said, “Eat Good Fat.” It was packed with my 32oz
jar of Ancients Organics ghee. I eat a dab of ghee on salted radish halves, a
sometimes snack before supper. It helps to get my supper k/g (ketogenic) ratio
above 1.5, a desired ratio which I easily achieve at breakfast and lunch. I
prefer Ancient Organics brand, although expensive, for its “delicious sweet and
nutty flavor” and its “incredible caramelized aroma.” It’s also “cooked in small
batches over open flames” and made from “milk of grass fed and pastured cows.” It’s really good fat!

But this is not a column about ghee. It’s about the
roiling transformation in the world of nutrition concerning dietary fats in
general and saturated fats in particular. Saturated fats are enjoying a
Renaissance everywhere except in
government and “public health” circles, principally the USDA and ACC/AHA. The
reason simply is that these institutions have been bought and paid for by their
commercial interest supporters. But this column is not another rant about that
either. It is about two major scientific papers in influential medical journals
that deserve more attention.

The first study was a really large mostly
British meta analysis (643k participants), published last March in the Annals of Internal Medicine, of 49
observational studies and 27 randomized controlled trials, in part funded, by
the way, by the British Heart
Foundation. The title: “Association of Dietary, Circulating, and Supplement
Fatty Acids with Coronary Risk: A Systematic Review and Meta-analysis. The CONCLUSION: “Current evidence does not
clearly support cardiovascular guidelines that encourage high consumption of
polyunsaturated fatty acids and low consumption of total saturated fats.”

The second study appeared in the British Medical Journal (BMJ) in 2013
and was titled, “Use of dietary linoleic acid for secondary prevention of
coronary heart disease and death: Evaluation of recovered data from the Sydney
Diet Heart Study and updated meta-analysis.” (“Secondary prevention” is to
prevent a heart attack in those who already have heart disease. “Primary
prevention” is for those who do not
already have Coronary Heart Disease (CHD).) This Australian study concluded:

“Advice to substitute polyunsaturated fats for saturated fats is a key
component of worldwide dietary guidelines for coronary heart disease risk
reduction. However, clinical benefits of the most abundant polyunsaturated
fatty acid, omega 6 linoleic acid, have not been established. In this cohort, substituting dietary linoleic acid in place of
saturated fats INCREASED THE RATES OF
DEATH FROM ALL CAUSES, CORONARY HEART DISEASE, AND CARDIOVASCULAR DISEASE. An
updated meta-analysis of linoleic acid intervention trials showed no evidence
of cardiovascular benefit. These findings could have important implications for
worldwide dietary advice to substitute omega 6 linoleic acid, or
polyunsaturated fats in general, for saturated fats.” (Emphasis added by me,
obviously. I wish I could just SHOUT IT FROM THE ROOFTOPS!)

The reference to “advice to substitute
polyunsaturated fats for saturated fats” as a “key component of worldwide
dietary guidelines” and “these findings could have implications for worldwide
dietary advice” couldn’t be more pointed. The U.S. Dietary Guidelines Advisory
Committee, currently preparing the 2015 update, is expected to double
down in the coming months on their advice to substitute
polyunsaturated fats from processed vegetable and seed oils. Alice H. Lichtenstein, D. Sc., Vice-chair, “2015
Dietary Guidelines Advisory Committee, U.S. Department of Agriculture/U. S.
Department of Health and Human Services,” is in charge and is also the lead
author on the AHA’s current “Diet and Lifestyle Recommendations.”

Lichtenstein also served on the AHA committee in
which Robert H. Eckel, M.D., was co-chair and
lead author of the “2013 AHA/ACC Guideline on Lifestyle Management to Reduce
Cardiovascular Risk, A Report of the American College of Cardiology/American
Heart Association Task Force on Practice Guidelines.” Together, they are a formidable
force.

The current 2010 Dietary Guidelines state (pp. 24-25), “Saturated
fatty acids contribute an average of 11 percent of calories to the diet, which
is higher than recommended. Consuming less than 10 percent of calories from
saturated fatty acids and replacing them with monounsaturated and/or
polyunsaturated fatty acids is associated with low blood cholesterol levels,
and therefore a lower risk of cardiovascular disease. Lowering the percentage
of calories from dietary saturated fatty acids even more, to 7 percent of
calories, can further reduce the risk of cardiovascular disease.” That’s the status
quo ante.

Now, there is rampant speculation that the new 2015
Dietary Guidelines for Americans will recommend “a dietary pattern that
achieves a macronutrient composition of 5% to 6% saturated fat, 26% to 27%
total fat, 15% to 18% protein, and 55% to 59% carbohydrate.”Why? That is the further reduction in
saturated fat consumption that Eckel and Lichtenstein, et al., teamed up to recommend in the ACC/AHA Practice Guidelines,
as published in Circulation, the
organ of the American Heart Association. “Strength of evidence: high,” they
said (Table 10, pp
17-18).
Such is the current state of affairs in U. S. dietary matters. Does it sound
eerily like the world of domestic politics? And
we have to vote every day with the
food choices we make. So, choose wisely and remember the roiling
transformation is trending away from PUFAs and toward SFAs.

Are you afraid to “go against” the “Dietary
Guidelines” or the practice guidelines your doctor is required to follow? Do
you avoid whole eggs, full-fat milk, yogurt and cheese, or red meat? Ask
yourself why? You doctor is trapped, but you’re not…

Saturday, December 6, 2014

‘John,’ the
‘bot who (that?) is the “coach” I selected at www.Fit2Me.com, sent me
my first “coach email” a few days ago. (Fit2Me is a website that I learned
about through a TV ad and signed up for. It is sponsored by AstraZeneca, the
drug company.) So, I thought I would read it and offer this critique of ‘John’s’
approach to mentoring me. It’s a fairly short email, with introductory
paragraph, three bullet paragraphs, and a summary wrap-up with some rah-rah
encouragement.

“Cravings can be tough,” John begins. “It’s not just
because the food is right there, but many times it comes out of nowhere and
that’s really hard to handle. That’s why I thought I would reach out to you
with some suggestions.”

Cravings.
What are they anyway? For me cravings fall into 2 categories: 1) hunger
cravings, which I never, ever have;
and 2) ideas about eating something, which I frequently have, usually before or
after supper. I am excluding opportunistic eating from the category of
cravings. That is when I see food. My eye and my brain then conspire against me
to eat food, usually too much. The buffet falls into this category too. The
solution is simply to control the beast.
I’ve not always been successful.

Hunger
craving are non-existent because I eat a Very Low Carb, high-fat diet. When you
eat this way, you will not be hungry. You will have no “need” (from hunger
cravings) to snack between meals because your blood sugars will be stable.

●“It’s not
easy,” John says, “but a little preparation can really help deal with
temptation. Keep some type 2 diabetes friendly snacks with you. There’s plenty
at Fit2Me. These can really come in handy when you are tempted because it is
much easier to say ‘no’ when you have something to say ‘yes’ to.”

This makes
no senseat all to me. First, if you eat LCHF, you will not be hungry so the only thing you will
be “tempted” to do is to eat an unnecessary
snack just because you know you have it
with you! In fact, you are not saying ‘no’ at all; you are actually saying
“yes.” You are actually caving into temptation, not hunger. That is not the best way to control the beast.

●“If you’re
going out to eat with friends or the work crowd, look ahead at the menu and
know what you are going to order. It really helps to keep you from having to
choose on the spot, plus it gives you more time to hobnob with the ‘in crowd.’”
(That’s funny. In social network theory, our type 2 diabetic person would
appear to be an outlier.)

Once again,
‘John’ (I’m talking to a robot!), I think this is a bad idea. If you look ahead
at the menu you are just going to be thinking about food too much. Everyone on
a diet knows this. It is easy to obsess about food. It is better to just pick
up the menu, select an appetizer or a salad and be done with it. Just avoid all
fried foods and most prepared salad dressings.

●“Remember
your trade-offs. If you think you are going to be in a situation where you have
to eat more than you want to, just try to keep the portions small, plus plan on
how you’re going to burn off some of those extra calories with an exercise.
There are lots of activities to use to trade-off some calories on Fit2Me,” ‘John’
says.

Oh great!
Plan to fail. Plan to be in a situation where “you have to” eat more
than you want, and then rationalize this planned indulgence with a “Hail Mary”
around the track. Does anyone think that exercise is a good way to lose weight?
Penance is great, but penance doesn’t shed weight; it just sheds guilt. To repeat,
the solution is simple: control the beast.

John’s summation: “Temptation comes in a lot of forms
and at all times of the day. Stay ahead of temptations by planning ahead. Use
your meal planner, build an activity plan to help you with trade-offs, and keep
some healthy snacks ready. It’s all there with Fit2Me. After all, we know that
you are going to have to deal with cravings, and that’s why we built Fit2Me to
be all about you. Remember, I am behind
you every step of the way.”

Now we’re
talking “temptation” again. That’s a different subject from “cravings,” whether
“hunger cravings” or just ideas about snacking before or after supper, where ‘John’
and I began. Temptation is still tough for me. I am a trough feeder. But
cravings are easily managed: 1) eat LCHF and you won’t get “hunger cravings,”
period. You won’t need to snack, honestly.

Then, if you want a
drink (and a snack), and have a habit of having them before
supper, (as I do)) pick a LCHF snack
like radishes with salt and butter. And after supper, to break the habit of
“nervous eating,” simply control the
beast. Just plant another idea in your head (if a “snack” impulse comes
up), e.g. think about that fasting blood
sugar you will have in the morning if you resist
the temptation. Last week most of mine were in the 80’s and 90’s. I even
had an 82 one morning!

Wednesday, December 3, 2014

“The
world’s healthiest foods” (http://whfoods.org/ ) is a
popular website that came to my attention a few years ago for their “in-depth
nutrient profile” of the recipes they feature. Some of my favorite recipes are
stovetop poached fish and vegetable dishes. There are no meat recipes, however,
keeping with their altruistic mission “to help make a healthier you and a
healthier world.” It’s otherwise a good site, so I can live with their bias – except when I think they are misleading
us.

This
morning's recipe for a “High Energy Breakfast Shake” on their site is
described as a “quick-and-easy, nutritious and delicious addition to your
Healthiest Way of Eating. And a great way to start the day!” Here are the
ingredients:

●1 medium banana

●½ cup whole strawberries

●1½ cups of low-fat milk

●2½ Tbs almond butter

●2 Tbs ground flaxseeds

●1½ Tbs blackstrap molasses

Blend all
ingredients until smooth. Serves 2. (I dare
you to make this shake and not
drink the whole recipe yourself!)

One “serving” (HALF
the recipe) contains 363 calories, 11.22g protein, 18.71g fat and
42.50g of carbs*, of
which 27.17 are sugars. The full recipe is 85 grams of carbs.
The shake is lowest in saturated fats, moderate in polyunsaturated fats and
highest in monounsaturated fats. The “high energy” comes from the “sugar” jolt,
and not just the simple sugars. The total carbs includes polysaccharides (long
glucose chains) that are “predigested” by the
blender to make them a liquid.

Quotingfrom “How
do energy drinks work?” in the Science section of How Stuff Works, “Energy
drinks are supposed to do just what the name implies -- give you an extra burst
of energy. As it turns out, most of that ‘energy’ comes from two main
ingredients: sugar and caffeine.” Well, the “High Energy Breakfast
Shake” contains no caffeine.
It’s all sugar.

But if this shake did contain caffeine (as in a Red
Bull “energy drink” with 76.5mg), “Caffeine works by blocking the
effects of adenosine, a brain chemical involved in sleep. When caffeine blocks
adenosine, it causes neurons in the brain to fire. Thinking the body is in an
emergency, the pituitary gland initiates the body's ‘fight or flight’ response
by releasing adrenaline. This hormone makes the heart beat faster and the eyes
dilate. It also causes the liver to
release extra sugar into the bloodstream for energy [emphasis added].Caffeine
affects the levels of dopamine, a chemical in the brain's pleasure center. All
of these physical responses make you feel as though you have more energy,” according
to How Stuff Works.

I’m writing
this on the day after Halloween (All Hallows’ Eve, October 31st).
The kids who went door-to-door in costume last night came home laden with
candy, both in their baskets and their tummies. As we all know, sugar gives you
that “extra burst of energy” because it is digested first and quickly. And everyone who gets a sugar jolt sees
their blood sugar rise. If your metabolism is working well, your serum insulin also rises and carries the “sugar”
into your cells where it is used or stored. What isn’t used or stored in
muscles returns to the liver to be stored as glycogen and your “sugar” drops.

So we
expect that binging on sugar, and sugary drinks especially, will certainly
produce “high energy.” We joke that kids on sugar highs behave like “Energizer Bunnies” until
they crash and fall asleep. Adults will too, especially if you start your day
with this “high energy” breakfast shake. By mid-morning you will be in a slump…
and hungry again. You are a
sugar addict.

And if you
have or are developing a slightly compromised glucose metabolism (or worse),
then you no longer have the 1st insulin response. You also now have
fewer functioning beta cells in the pancreas to produce insulin, and your destination cells have developed
insulin resistance, which is to say they do not “take up” the glucose that the
insulin is circulating in your blood. As a result, your blood sugar spikes through the roof and stays high,
and the continuously circulating “sugar” damages your beta cells and starts to
cause the
dreaded complications.

About Me

I was diagnosed a Type 2 diabetic in 1986. I started a Very Low Carb diet (Atkins Induction) in 2002 to lose weight. I didn’t realize at the time that it would put my diabetes in clinical remission, or that I would be able to give up almost all of my oral diabetes meds. I also didn’t understand that, as I lost weight and continued to eat Very Low Carb, my blood lipids would dramatically improve (doubling my HDL and cutting my triglycerides by 2/3rds) and that my blood pressure would drop from 130/90 to 110/70 on the same meds.
Over the years I changed from Atkins to the Bernstein Diet (designed for diabetics) and, altogether lost 170 pounds. I later regained some and then lost some. As long as I eat Very Low Carb, I am not hungry and I have lots of energy. And I no longer have any of the indications of Metabolic Syndrome.
My goal, as long as I have excess body fat, is to remain continuously in a ketogenic state, both for blood glucose regulation and continued weight loss. I expect that this regimen will continue to provide the benefits of reduced systemic inflammation, improved blood lipids and lower blood pressure as well.